Healthcare Provider Details

I. General information

NPI: 1619102936
Provider Name (Legal Business Name): MICHELE DIPOLITO-MCCARTY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2009
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8407 NE 334TH ST
LA CENTER WA
98629-2822
US

IV. Provider business mailing address

8407 NE 334TH ST
LA CENTER WA
98629-2822
US

V. Phone/Fax

Practice location:
  • Phone: 360-936-9138
  • Fax:
Mailing address:
  • Phone: 360-936-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021626
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: